Slashdot Mirror
Killing Cancer By Retraining the Patient's Immune System
An anonymous reader writes "There's an interesting story on CNN about the University of Pennsylvania's human trial results on curing intractable cancer by retraining the patient's own immune system. Quoting: 'Nick Wilkins was diagnosed with leukemia when he was 4 years old, and when the cancer kept bouncing back, impervious to all the different treatments the doctors tried, his father sat him down for a talk. John Wilkins explained to Nick, who was by then 14, that doctors had tried chemotherapy, radiation, even a bone marrow transplant from his sister. ... A few months later, Nick traveled from his home in Virginia to Philadelphia to become a part of the experiment. This new therapy was decidedly different from the treatments he'd received before: Instead of attacking his cancer with poisons like chemotherapy and radiation, the Philadelphia doctors taught Nick's own immune cells to become more adept at killing the cancer. Two months later, he emerged cancer-free. It's been six months since Nick, now 15, received the personalized cell therapy, and doctors still can find no trace of leukemia in his system. ... Twenty-one other young people received the same treatment at The Children's Hospital of Philadelphia, and 18 of them, like Nick, went into complete remission -- one of them has been disease-free for 20 months.'"
AIDS
Cancer gets cured about once a decade, sometimes by real doctors, sometimes by "quacks." I could show stats from real doctors with similar results to this one, which never saw the light of day once it was discovered (or rediscovered).
People don't actually like creativity, even in medicine:
http://www.slate.com/articles/health_and_science/science/2013/12/creativity_is_rejected_teachers_and_bosses_don_t_value_out_of_the_box_thinking.html
In medicine, innovative things happen all the time. When *you* go to the doctor, you get the same ol' thing that has been done since 1952.
Doctors destroy health, lawyers destroy justice, universities destroy knowledge, religion destroys spirituality
California Stem Cell, Inc. has been doing a similar project since about 2005 in training white blood cells of a patient to recognize malignant melanoma cells out side the body, growing large numbers of those white blood cells and then reinjecting them back into the patient. To date they have achieved some very high remission/cure rates. They have FDA clearance pending but not yet issued. The process was originally developed by doctors at Hoag Hospital in Newport Beach, CA as I recall from a speach.
www.californiastemcell.com
You're correct about the fact that the term "cancer-free" essentially means "we can't detect very small numbers of cells" in common-sense English, but the fact remains that this therapy (which isn't exactly news, BTW) leaves a large persistent population or cancer-killing modified leukocytes in a patient's body even after a period of over a year, and reappearance of large numbers of cancer cells simply doesn't seem likely under these circumstances.
Ezekiel 23:20
My wife was part of a stage 3 melanoma study for the drug Ipilimumab (brand name Yervoy), an immunotherapy drug that inhibits the signal mechanism used by the immune system to turn off an attack. So any metastatic cells floating around her body would not be able to masquerade as normal cells by flying the right protein flag. Unfortunately, halfway through the trial she had a major reaction that caused brain swelling, requiring her to be hospitalized twice. Fortunately, she survived the side effects and the oncologist believes she had enough of the juice to get most of the benefit. Without the drug, we were looking at 50% survival rate for 5 years. The study is still in progress, so no idea how Ipilimumab will improve the odds.
There is research out there claiming green tea, spices like tumeric, and just eating better can have dramatic results. I would like to see some serious research by respected oncologists into the efficacy of simple life changes like that, instead of study after study pushing big pharma's insanely expensive drugs (thankfully covered by the trial in our case) that cause side effects potentially more dangerous than the disease they are intended to treat.
I don't know if reprogramming T-Cells like in TFA is more or less dangerous than conventional immunotherapy. Cancer makes people desperate enough to take some pretty big treatment risks. I certainly appreciate the fact that oncologists are aggressive in their mission to save lives, but I wish we had more non-fringe research into potentially good treatments that were also cheap and safe.
I am sure you can lower the risk with dietary choices. But in fact genetic mutations that lead to cancer do just happen - that is more physics than choice.
Some people have an evolutionary resistance to cancer in the way their killer t-cells target it more aggressively. Others contract the HIV virus and never get AIDS, and there has been interesting speculation folks with these immunities may be descended from plague survivors from centuries ago. If this immunity can be taught to a cancer-ridden patient's own immune system, essentially someone with no other options, its side effects can then be carefully studied. I would look carefully at autoimmune disorders first.
Happiness in intelligent people is the rarest thing I know.
Ernest Hemingway
It's also worth noting (not that it means that kiddo is necessary not doomed; but just as a general thing) that culling abnormal cells is something that the immune system does quite regularly. It doesn't always do it well enough; which is when you get to have a chat with the oncologist, but this isn't some fundamentally artificial capability that fades as soon as treatment stops.
If he has a cancer cell population that punched through the various safeguards and reached clinically relevant levels once, his odds are probably worse; but holding the line against some modest population of dangerously aberrant cells isn't a terribly abnormal condition.
A very close friend was supposed to go through this treatment almost two years ago. Unfortunately for him, you need to be is pretty good shape before this is begun and his cancer was spreading to various places in his body and he was never quite to the point where the doctors felt he could tolerate a new form of treatment. All I could think of was that the oncologists were stuck in a deadly game of whackamole; hit that place where the cancer was discovered and it popped up somewhere else. When the cancer spread to his brain, it was all over. By then his estimated of survival was, maybe, six weeks and he lasted less than a week after the discovery of it having gotten into the brain. Maybe if the original "We got it in time, there's nothing in the lymph nodes"[*] had been followed up with this treatment he'd still be around. When it was discovered to have returned it was probably already too late.
[*] -- The cancer that was discovered a couple of years ago was found to be the same one that he'd had surgery/chemo for years earlier. My feeling is that `clean' lymph nodes are probably a false hope. What evidence is there that cancer always leaves a trace in the lymph nodes anyway?
CUR ALLOC 20195.....5804M
I listened to the VP of marketing from Calif. Stem Cell recount that their limited trial of stage 4 melanoma patients had something like a 90% survival rate, which is astounding.
I know they are now getting ready to do a final 3rd clinical trial which is needed before final FDA clearance.
If you can genetically engineer cancer-killing T-cells, couldn't you just inject those into healthy patients (i.e. all the rest of us) as well, as a sort of immunization, just like you can get vaccination against influenza or tetanus?
Simply put, those T-cells wouldn't have the proper MHC. The body would recognize them as foreign, and the immune system would kill the injected T-cells.
That's one reason this works, but is so hard: they have to "load the weapon" by modifying a T-cell from the patient's own body. MHC is the same reason you can't just get an organ transplant from any random person... if it's not a match, the immune system will kill it.
People getting regular organ transplants take immunosuppressants, because even then the match isn't perfect. Obviously, it would be pointless to "transplant" immune cells to fight cancer, only to have to suppress... immune cells... in order to prevent the transplanted T-cells from being sniped by the immune system.
If you can genetically engineer cancer-killing T-cells, couldn't you just inject those into healthy patients (i.e. all the rest of us) as well, as a sort of immunization, just like you can get vaccination against influenza or tetanus?
The Chimeric Antigen Receptor T-Cell (CAR-T) technique actually requires a new lineage of modified cells to be created for each individual patient, engineered from each person's own immune cells. Unfortunately, this is an expensive and time-consuming task, and scaling to mass-production will be very difficult.
A second problem is that cancers may have differences from normal cells, but the differences are subtle compared to a microbe or virus -- precisely because they are not foreign, they are "us" in a sense, being born from our own normal cells. With exceptions (too few exceptions, unfortunately), there is no "cancer antigen" that marks it as being such. In this case, the patient has a cancer that arises from B-Cells. So what they've done is create a T-cell that ignores the usual proscription against attack the Self, and indiscriminately kills all B-cells (healthy or cancerous), wiping them all out.
Of course, B-cells are what produce Antibodies for us, so afterwards each patient needs a steady supply of IVIG (produced from the Antibodies in donated blood or plasma) to replace the Antibodies they are no longer producing. Still, it beats dying of Leukemia.
if researchers find a way to transform cancer from near-death sentence into a condition that people and their doctors can manage for decades, much as they do many other medical conditions today, then that's close enough to a "cure" as any of us could reasonably hope for. Or is that too difficult a concept for the average person on this myopia-infested site to handle?
The difference is that a treatment with ongoing costs is more like life support than like a cure. Insulin is not a "cure" for diabetes mellitus caused by pancreatic failure (type I). Nor is metformin a "cure" for diabetes mellitus caused by insulin resistance (type II). But I still agree with you that an upgrade from a horrible disease to a condition managed through life support is worthwhile.
A cure for cancer would make the patient a potential user of more drugs for conditions acquired later in life, such as drugs to control erectile dysfunction, drugs to increase bone density, drugs to control autoimmune arthritis, etc.
Even if there are cures, few can ever afford them
The next generation can more easily afford the generic knockoff of the cure once the patent has expired.
I would say this: as long as this therapy, even if it were to have serious side effects, simply lowers the mortality rate by, say, a factor of 2, it's a win. There is nothing else out there that, at the moment of introduction, would lower cancer mortality by such a factor, AFAIK. So far, presumably, most of the patients who received the therapy in this limited trial would have been dead by now. That's way, way over a 2x decrease in mortality. As far as I'm concerned, this is an unqualified success. Even if those patients turned into zombies 1 year from now, it'd still be a success, for crying out loud. There is nothing at this point in cancer therapy history that's this good, nor has there been anything that was that good on human subjects so quickly after the initial trials, IIRC. Feel free to correct me, of course.
A successful API design takes a mixture of software design and pedagogy.
Do people with HIV virus remember their PIN number at the ATM machine?
Only those associated with the USDRD Department of the U.S. (U.S. Department of Redundancy Department)
This space unintentionally left blank.